{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:08:37Z","timestamp":1790698117533,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine whether posterior tibial slope (PTS) measured to proximal anatomical axes can serve as a reliable proxy for PTS measured to the mechanical tibial axis (mTA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In patients \u226518 years with failed anterior cruciate ligament reconstruction, medial and lateral PTS were measured relative to the mTA on a lateral lower\u2010leg radiograph, and relative to the proximal tibial anatomical axis (PTAA), anterior tibial cortical axis (ATC) and posterior tibial cortical axis (PTC) on a lateral knee radiograph. Agreement was assessed using correlation coefficients, measurement error and Bland\u2013Altman analysis. Diagnostic accuracy of the conventional \u226512\u00b0 PTAA\u2010based PTS cut\u2010off for slope\u2010reducing osteotomy was determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010nine knees were analyzed. Correlation between proximal anatomical axes and mTA\u2010based PTS measurements was strong (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009\u2265\u20090.71), but agreement was poor. Mean measurement error for PTAA was 0.1\u2009\u00b1\u20092.4\u00b0 (range: \u22125.7\u00b0 to 7.6\u00b0) and \u22120.5\u2009\u00b1\u20092.4\u00b0 (range: \u22126.6\u00b0 to 5.2\u00b0), for ATC \u22123.4\u2009\u00b1\u20092.6\u00b0 (range: \u22128.6\u00b0 to 5.9\u00b0) and \u22123.7\u2009\u00b1\u20092.6\u00b0 (range: \u22129.9\u00b0 to 2.7\u00b0) and for PTC 3.0\u2009\u00b1\u20092.6\u00b0 (range: \u22122.9\u00b0 to 10.4\u00b0) and 2.7\u2009\u00b1\u20092.4\u00b0 (range: \u22123.6\u00b0 to 7.8\u00b0) for the medial and lateral plateau, respectively. For PTAA, absolute measurement error \u22652\u00b0 occurred in approximately 50% of knees. Bland\u2013Altman analysis showed 95% levels of agreement ranging from \u22124.89\u00b0 to 4.62\u00b0 (medial) and \u22125.11\u00b0 to 4.11\u00b0 (lateral). Using the \u226512\u00b0 cut\u2010off on PTAA\u2010based PTS values misclassified approximately one in three knees (19.5% false\u2010positive and 13.2% false\u2010negative) relative to the mTA\u2010based PTS reference values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite strong correlation, proximal anatomical axes\u2010based PTS measurements on routine lateral knee radiographs show substantial, bidirectional measurement error outside clinically acceptable limits of agreement compared to mTA\u2010based PTS measurements on full\u2010length lateral lower\u2010leg radiographs. Single\u2010exposure, full\u2010length lateral lower\u2010leg radiographs should be obtained to measure PTS relative to the mTA when considering slope\u2010reducing osteotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70093","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T14:40:52Z","timestamp":1761144052000},"page":"3575-3585","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Proximal anatomical axes show bidirectional variability: Accurate tibial slope requires mechanical axis measurement"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2215-6746","authenticated-orcid":false,"given":"Barbara C.","family":"Boer","sequence":"first","affiliation":[{"name":"OCON Centre for Orthopaedic Surgery and Sports Medicine Hengelo the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2774-6246","authenticated-orcid":false,"given":"Quinten W. T.","family":"Veerman","sequence":"additional","affiliation":[{"name":"OCON Centre for Orthopaedic Surgery and Sports Medicine Hengelo the Netherlands"},{"name":"Department of Biomechanical Engineering, Faculty of Engineering Technology University of Twente Enschede the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7325-0647","authenticated-orcid":false,"given":"Reinoud W.","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Martini Ziekenhuis Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-8608","authenticated-orcid":false,"given":"Judith","family":"olde Heuvel","sequence":"additional","affiliation":[{"name":"OCON Centre for Orthopaedic Surgery and Sports Medicine Hengelo the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2005-0550","authenticated-orcid":false,"given":"Tony G.","family":"van Tienen","sequence":"additional","affiliation":[{"name":"Kliniek Viasana Mill the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6834-4438","authenticated-orcid":false,"given":"Wolf","family":"Petersen","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Orthop\u00e4die und Unfallchirurgie Martin Luther Krankenhaus Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1588-086X","authenticated-orcid":false,"given":"Roy A. 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